AB1447 VALIDITY OF ULTRASONOGRAPHY IN DETECTING ENTHESITIS IN CHILDREN: A SYSTEMATIC LITERATURE REVIEW
Authors: L. Rossi-Semerano, V. Ravagnani, P. Collado, J. Vojinovic, J. Roth, S. Magni-Manzoni, E. Naredo, M. A. D’agostino, S. Jousse-Joulin
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Several studies have suggested a potential role for ultrasonography (US) in detecting enthesitis in children, thus enhancing the accuracy of the classification of juvenile idiopathic arthritis (JIA) and improving the therapeutic approach. Because of no consensual definition of ultrasonographic enthesitis in children, the pediatric sub-taskforce of the OMERACT working group posed the research question of whether there are sufficient data to support the role of US in the diagnosis and follow-up of enthesitis in JIA, particularly enthesitis related arthritis (ERA). <h3>Objectives</h3> We performed a systematic literature review (SLR) to assess the value of US for detecting enthesitis in JIA. The main objectives were to determine: i.which elementary lesions have been evaluated by US in JIA patients; ii.which definitions and scoring systems were used; and iii.the measurement properties of US in evaluating enthesitis in JIA according to the OMERACT Filter 2.1 Instrument Selection Algorithm (OFISA). <h3>Methods</h3> PubMed and Embase databases were searched for articles published from January 1966 to May 2022; we selected those meeting the inclusion criteria according to the US definition of enthesitis and metric properties studied. We assessed the clinical features of the population, study design, the type and number of entheses examined, the definition and scoring system of US enthesitis and metric properties according to the OMERACT filter (truth, discrimination, feasibility). The quality of the studies was evaluated with the Quality Assessment of Diagnostic Accuracy Studies 2. <h3>Results</h3> Five publications met the inclusion criteria (26 to 146 patients and 1 to 10 bilaterally examined entheses)<sup>[1-5]</sup>. All studies focused on lower-limb entheses. The elementary lesions included in the definition of adult enthesitis were generally assessed. Few studies reported US reliability, and none evaluated sensitivity to change of US. US revealed entheseal abnormalities in 9.4% to 53% of JIA patients and 20% to 83% of enthesitis-related arthritis cases. No significant abnormalities were found in healthy children. US findings were poorly correlated with clinical examination. The overall quality of the studies was low, mainly because of the lack of a reference standard. <h3>Conclusion</h3> US could be a sensitive tool to detect entheseal abnormalities in JIA. Nevertheless, the current evidence highlights that a standardized US definition of enthesitis in children is lacking and US criteria and discriminant validity have not been established. <h3>References</h3> [1] ousse-Joulin S, Breton S, Cangemi C et al. Ultrasonography for detecting enthesitis in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2011 Jun;63(6):849-55. [2] Shenoy S, Aggarwal A. Sonologic enthesitis in children with enthesitis-related arthritis. Clin Exp Rheumatol. 2016 Jan-Feb;34(1):143-7. [3] Guo R, Cao L, Kong X, Liu X et al. Fever as an initial manifestation of enthesitis-related arthritis subtype of juvenile idiopathic arthritis: retrospective study. PLoS One. 2015 Jun 1;10(6):e0128979. [4] Laurell L, Court-Payen M, Nielsen S et al Ultrasonography and color Doppler of proximal gluteal enthesitis in juvenile idiopathic arthritis: a descriptive study. Pediatr Rheumatol Online J. 2011 Aug 11;9(1):22. [5] Weiss PF, Chauvin NA, Klink AJ et al. Detection of enthesitis in children with enthesitis-related arthritis: dolorimetry compared to ultrasonography. Arthritis Rheumatol. 2014 Jan;66(1):218-27. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.